<!DOCTYPE html> 
<html>

<head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1"> 
    <title>Split it up</title> 
</head> 

<body> 
<div data-role="page" id="new-bill">
	<div data-role="header" data-position="fixed">
    	<a href="start.html" data-icon="arrow-l" data-role="button" data-rel="back">back</a>
    	<h1>new bill</h1>
	</div>
    <!-- /header -->
    
    <div data-role="content">   
    	<form id="form-new-bill">
            <ul data-role="listview" data-inset="true">
            	<li data-role="fieldcontain">
	            	<label for="bill-name">bill name:</label>
	            	<input type="text" id="bill-name" name="bill-name"/>
            	</li>
            	
	            <li data-role="fieldcontain">
	            	<button type="submit" data-theme="b" name="submit" value="submit-value">done</button>
                </li>            
            </ul>	
    	</form>
    </div><!-- /content -->
</div><!-- /page -->
</body>
</html>